Common Contracts

Electronic Funds Transfer (EFT) Authorization Agreement

Eft Authorization Agreement • June 21st, 2013 • Illinois

• Contract Type
  Eft Authorization Agreement
• Filed
  June 21st, 2013
• Jurisdiction
  Illinois

This EFT Authorization Agreement must be fully completed, signed and returned via fax to the Blue Cross and Blue Shield of Montana (BCBSMT) Electronic Commerce Center at 312-946-3500.

This EFT Authorization Agreement must be fully completed, signed and returned via fax to the

Eft Authorization Agreement • February 21st, 2012 • Oklahoma

• Contract Type
  Eft Authorization Agreement
• Filed
  February 21st, 2012
• Jurisdiction
  Oklahoma

A voided check from the provider’s account or a letter from the financial institution on financial institution letterhead specifying the provider’s name, the account and financial institution routing/ABA number must be included with the signed EFT Authorization Agreement.